What's the matter with many black spots around the hands in the skin after blood draw

Due to the tightness of the clothes above the blood collection point, the patient generally only takes off the coat of the limb on the blood collection side, and lifts the rest of the clothes, so that the clothes above the blood collection point are too tight, compressing the blood vessels, increasing the resistance of the blood returning to the heart, and blocking the blood backflow. The vascular needle overflows, forming subcutaneous congestion. 2 Improper method of compressing the puncture site is one of the main causes of subcutaneous congestion. During venipuncture, the needle first penetrates the skin and then travels subcutaneously for a while into the blood vessel, so that the eye of the needle on the skin and the eye of the blood vessel are not in the same location. Some patients only focus on compressing the pinholes on the skin, but the pinholes on the blood vessels in the skin are bleeding, forming subcutaneous congestion[1]. 3 Short compression time after blood collection is another major cause of subcutaneous congestion. Patients often think that the epidermal pinhole does not bleed, that is, the compression is in place and will not continue to compress. In fact, the blood vessel wall is still bleeding at the pinhole, and the local skin may or may not be raised, resulting in subcutaneous congestion. 4 Rubbing The patient lacks relevant knowledge. While pressing, twist the cotton ball to rub the eye of the needle, so that the eye of the needle on the blood vessel is just glued and then rubbed open, which affects the progress of local coagulation and aggravates the bleeding. 5. Premature exertion of the limbs on the blood collection side Some patients immediately perform the exertion of the limbs on the blood collection side immediately after blood collection, which makes the blood pressure in the blood vessels abruptly, and opens the just-closed needle eye again, resulting in subcutaneous congestion. 1.2 Improper operation by nurses 1.2.1 Improper operation before puncture Because of the quality of the syringe, needle barbs often occur, causing mechanical cutting damage to blood vessels when the needle is inserted and withdrawn. 1.2.2 Improper operation during puncture (1) The angle is wrong. Disposable 5ml syringes cause a large angle between the needle and the punctured skin due to the syringe. It is difficult to grasp when the needle enters the subcutaneous needle in parallel, and it is easy to puncture the blood vessel wall and cause subcutaneous congestion [2]. (2) Needle speed is too fast. If the needle pierces the skin too fast and the needle penetrates too deeply, it is easy for the needle to penetrate the blood vessel wall, causing blood to flow into the blood collection device and into the subcutaneous at the same time, causing congestion. (3) Repeated puncture. A variety of reasons make the puncture operation process unsmooth, resulting in repeated puncture and damage to blood vessels to form subcutaneous congestion. (4) Hematoma at the needle insertion site. After the needle enters the skin, it should run in parallel for a period of time and then enter the blood vessel to avoid direct entry to avoid hematoma at the needle insertion site. (5) During the suction process, the position of the needle plug is not fixed, the needle tip slides in the blood vessel, penetrates the contralateral or lateral blood vessel wall, the blood overflows, and the local skin bulges, forming subcutaneous congestion. (6) Excessive pressure during suction. A small number of patients have varying degrees of vascular sclerosis, resulting in thickening of the vascular wall, narrowing of the lumen, poor vascular elasticity, and increased fragility. Excessive pressure during suction can cause the vascular wall to rupture to form a hematoma. 1.2.3 Improper operation after puncture (1) Routine quick needle extraction. The longitudinal axis of the needle tip cannot be kept parallel to the longitudinal axis of the blood vessel. When the needle is pulled out, the needle edge causes mechanical cutting damage to the blood vessel, and blood overflows from the damaged blood vessel, causing local skin bulge. (2) Pull out the needle while pressing the puncture site. The cotton ball presses the needle to pull out the needle, the blood vessel wall is compressed, the needle is pressed down, and the needle is like a small blade. The blade of the knife damages the blood vessel wall and is easy to form subcutaneous congestion. (3) Compression with alcohol cotton ball to stop bleeding. Alcohol is highly irritating to the skin and blood vessel wall needle injury, which is not conducive to wound healing and hemostasis. 1.3 Other Individual patients with coagulation dysfunction. Warm, encourage the patient to take off the tight underwear, avoid the tight clothing above the blood collection point, and protect the patient's privacy while keeping warm. Nurses try to assist patients in compression after blood collection and demonstrate. The correct way to press is: mainly to press the needle eye on the blood vessel, do not rub. After the needle is pulled out, the forearm should be straightened, or the forearm should be straightened and then lifted slightly, and the index finger and middle finger of the other hand should be used to compress the needle eye and the upper part along the vein. More than two puncture points. Do not bend the elbow to stop bleeding, because bending the elbow will increase a certain resistance to the blood returning to the heart from the venous network on the back of the hand, so that the blocked blood will overflow from the vascular needle eye, resulting in subcutaneous congestion. Correct time for pressing: moderate pressure for at least 3-5 minutes, if the coagulation function is poor, the pressing time is longer. The pressure is sufficient, the platelet cohesion at the needle eye of the blood vessel wall is enhanced, which is conducive to hemostasis. If conditions permit, a wall clock can be placed in the blood collection room to facilitate the patient to grasp the compression time. Avoid strong movement of the limb on the blood collection side within 1 hour after blood collection, so as to prevent the newly glued needle eye on the blood vessel from splitting, blood overflowing, and subcutaneous congestion. 2.2 Problems that nurses should pay attention to during the operation It is necessary to do "three checks" during puncture. Check the quality of the syringe before blood collection, and wipe the needle tip with a sterile dry cotton ball in the direction of the needle head for suspected barbed needles. For blood vessels with sliding, poor elasticity, and repeated puncturing without blood return, a sterilized index finger can be used to touch according to the anatomical position of the blood vessel, and then the needle is inserted after finding out the direction of the vein. wall and lead to failure. When suctioning, the syringe piston should be pulled slowly, and the piston should not be pulled to the top with one force. When pulling out the needle, keep the needle parallel to it in the blood vessel, slowly pull out the needle outward, and then quickly pull out the needle when it is about to pull out of the vessel wall. Immediately after needle withdrawal, apply pressure to stop bleeding with sterile absorbent dry cotton balls or sterile dry gauze. Follow-up question: How to remove the dark spots inside the skin Answer: The dark spots on the surface are actually congestion, there is nothing to worry about, it will disappear gradually, just take a hot compress

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